By Jen:

**WARNING** This post is a controversial subject in the WLS Community. Please keep your comments resectful.

I am not a doctor or nutritionist, all the information given here has come from my own personal research in articles and books on weight loss surgery. If you would like to know my sources, let me know and I will provide a list. <3 Jen <3 

One of the largest concerns in the WLS community is weight regain. It happens to almost everyone at one point in time or another, for varying reasons. There are many different methods to getting back on track, and one of those designed for RnY and Lap Band patients was the Pouch Test or Pouch Reset.

This reset program was specifically designed with the RnY patient in mind. Many times the bariatric pouch that an RnY-er or Bander has can stretch, allowing them to eat more food than they should be able to. The pouch test is designed to re-shrink the pouch back to close-to-post-surgery size. It works beautifully and does exactly what it’s designed to do.

BUT … recently I have seen many sleevers turn to this test and it breaks my heart. The pouch reset was not designed for a sleever and will not work for a sleever the same way it works for someone with a pouch – because we don’t have a pouch, we have a sleeve.

The VSG surgery works very differently than any other surgery in the past. The sleeve itself is made from the firm tissue of the stomach, which will not stretch as easily as the pouch (which is made from the stretchy part of the stomach). Because the sleeve does not stretch the same way, when a sleever gains weight it’s usually for vastly different reasons. Here are a few of those reasons a sleever might regain weight:

1. The sleeve has relaxed into it’s final volume capacity, and you are now able to eat more. When this happens, sleevers will usually regain 5-10 lbs. This is absolutely normal and considered to be “acceptable” levels of weight gain.

2. Your diet is lacking. You might be eating too many carbs, too much or too little protein, or too much or too little fat. You might not be getting enough fruits and vegetables in your diet, or may have re-introduced things like sugar, alcohol, or *gasp* soda.

3. You’re not exercising. You may have stopped going on that daily walk or walked away from your gym membership. Whatever the reason, you’re just not moving as much as you were.

4. You’re not hydrating yourself. You may not be drinking enough water. Or you may be drinking only liquids sweetened with sugar substitutes (which can actually cause dehydration and weight gain).

The pouch test is not designed to address any of these issues and, while a sleever might lose some weight doing it, they may go right back into old habits and regain the weight – plus more (remember the yo-yo cycle?).

Rather than turning to a program designed for another surgery, I recommend the following actions for a sleever to get back on track:

 1. Keep a food log and write down everything you eat. This will give you a good gauge of what you’re ACTUALLY eating every day. After about a week, look back on it and see if there’s anythin      you’re noticing (carbs, sugar, lack of vegetables, etc.) and you can adjust your diet accordingly. You may have to change your eating plan up and return to high-protein/low carb, move to a more plant-based eating plan, or maybe even add in some more fat to your diet (from salmon, avocados, nuts, etc.).

2. Start moving again. Even if it’s just a five minute brisk walk around the block, get out and get your blood pumping a bit.

3. DRINK PURE WATER. People HATE this, but it’s a MUST. If drinking a full 16.9 bottle of water is daunting, start with the smaller 8 oz. “kid” size bottles. Drink at least eight of those (smaller ones). The excuse “I hate water” doesn’t really cut it. No one LOVES water (well, some people do). But the fact of the matter is, nothing will hydrate you better (future post on that later).

4. Go to a support group. Find one in your area. If there’s not one in your area, don’t be afraid to drive to find one. Face to face support groups are SO important!

One of the reasons the pouch test bothers me so much is because there seems to be an attitude in the bariatric community that all surgeries are the same and should be treated the same, and this is simply not true. Each surgery is different with it’s own quirks, benefits, and downsides. Not one surgery behaves the same as another, and to throw us all into one basket is detrimental to the patient. I am hopeful that the medical community will finally start to see this and stop treating sleevers like we have a pouch someday.

God’s love and blessings on you all!